Ever thought you were getting the shaft when it comes to selling drugs and supplies? If so, you’re not alone. Rx flea-and-tick supplies, monthly heartworm meds, must-stock anti-inflammatories and antibiotics (among others)? If you’re like a lot of us, you’re caught between a rock and a hard place. Not only is it getting tougher to turn a profit on drugs based on the big-hit financial outlays, spooky interest rates, skyrocketing shipping charges and creeping inventory management costs, but we’re expected to stock them. If we didn’t, the grumbling would reach an uncomfortable crescendo, as happened to us recently when we temporarily decided to outsource many of our ophthalmology drugs. Moreover, most of us are in no position to dismiss a profit center, no matter how minimal the margins. This economy is taking no prisoners and few of us can afford the luxury of discarding any source of income—minuscule and headachy though it may be. Caught in the Act Enter the “Fairness to Pet Owners Act” proposed by Congress. This bill is being touted by its backers as a necessary bit of consumer protection legislation that would require us to inform our clients of their choices when it comes to purchasing prescription items. Which is a reasonable enough request. After all, everyone deserves a choice. And now that even the biggest veterinary-only Internet pharmacies around are VIPPS certified, there’s no earthly reason why we should refuse on the basis of patient safety, right? But this proposed legislation goes further than a mere disclosure requirement. It doesn’t merely require us to offer a choice, it mandates a legal paper trail as proof of our recommendation. According to the AVMA’s email blast on the subject: “H.R. 1406 would impose new stipulations on veterinary prescriptions. The bill requires a veterinarian to 1) write a prescription whether or not he/she will dispense the product; 2) provide a written disclosure notifying clients that they may fill prescriptions at the veterinary clinic or at an off-site pharmacy; and 3) verify a prescription electronically or by other means consistent with applicable state law.” Additionally, a veterinarian may not: • “Require the purchase of an animal drug for which the veterinarian has written a prescription; • “Charge a client a fee for writing a prescription as part of (or in addition to) the fee for examination and evaluation of a pet; or, • “Require a client to sign, or supply a client with, a waiver or liability disclaimer should the prescription be inaccurately filled by an off-site pharmacy.” Whew! I’m exhausted just reading about all the fun new practices I’ll have to employ for the privilege of medicating my patients. Our office manager would be doubly exhausted except for the fact that she’s busy having a seizure at the moment. And who can blame her? After contemplating the impending implosion of our practice management software—that is, once we ask it to spit out all the required disclosures and prescriptions along with all their attendant “void whens” and “valid only ifs” for each separate invoice—one could be excused the indulgence of a meltdown. After all, if you internalize the basics of the legislation you’ll start to recognize the inherent disorderliness of the client invoicing process should it come to pass: OK, Mrs. X, here’s your Rx. Sign here to have it filled right now. Sign here to attest to the fact that we didn’t mischaracterize your alternatives, unduly entice you or otherwise coerce you into buying Fluffy’s drugs at our hospital. Oh, I’m sorry, Mrs. X, a pen will not do. Blood is so much more binding, don’t you think? The Dangers All these rules might even be OK if we had the option to be rid of the in-hospital pharmacy forever. Indeed, I’d love nothing better than to dispense with this stressor so we could all get back to getting paid exclusively on the basis of veterinary services rendered. Counting pills is not where my staff shines. Yet the Catch-22 remains: We have no choice but to stock these meds for our clients’ convenience and their insta-availability in the face of acute patient unwellness. Unfortunately, this bill proposes to make that process more expensive for us...and for our clients, once we pass along this higher cost of doing business. This legislation is absurd, really. But then, no one’s ever known the legislative crowd to follow through with a rational feasibility study before vomiting their breakfast into their bills. Still, I can’t help thinking it’s not the in-the-beltway set that’s ultimately to blame for asinine regs threatening to bite us all in the butt. No, ultimately this one’s on us. “Kicking and screaming” and “from my cold, dead hands” is how some veterinarians I know have characterized their feelings on the subject of willingly offering alternatives to in-house drugs. Plenty of us refuse outright to outsource drugs at all. To wit, about half of all states leave it up to us to determine whether we will or won’t offer our clients a written prescription when our clients ask for one. (“It’s hospital policy, ma’am.”) This is a practice the AVMA has deemed unethical. Yet our leading organization has never come anywhere close to condemning it, demonstrating more of the same kind of lukewarm leadership that colors similar pocketbook issues. State and local VMAs have also been loath to cry foul when practitioners routinely engage in this brand of personal income stream protectionism, in some cases going so far as to lobby for a status quo that would allow our colleagues a free hand to decide whether to script out drugs. Given our obvious degree of reluctance to self-police on this issue, is it any wonder the federal government is now advancing legislation to drag us kicking and screaming into the modern drug retail industry? I’ll agree, there’s no doubt this legislation deserves nothing better than to line the cages of our kennel wards. Yet on this issue in particular, I welcome the outside influence. We had it coming. I mean, is there anything more un-American than to stand in the way of the free market? Is there anything less neighborly and charitable than to refuse to offer an honest choice? It was only a matter of time before someone called us out. Dr. Khuly is a mixed-animal practitioner in Miami and a passionate blogger at Vetstreet.com. She earned her veterinary degree at the University of Pennsylvania and her MBA at Wharton.
